We Can Help “Red Flag” Pain
At some point in our lives, every one of us will unfortunately experience back pain, but airline employees and airport workers - from
baggage handlers to flight attendants to pilots- are especially at risk. The physical and economic impact of low back pain is enormous.
Most of the time back pain is minor and related to a pulled muscle or a sprain. However, there are some warning signs that should
prompt a visit to a spine specialist. In my article, we’ll discuss the “red flags” that require urgent medical attention by a spine specialist.
Richard Obedian, M.D.
Orthopedic Surgery RED FLAGS worth calls 516-933-4350
AIRPORT VOICE, JUNE 2019 13
1. Unremitting and severe pain and
atypical back pain. Back pain that lasts
longer than 6 weeks raises a red flag
because 80% to 90% of all episodes of
low back pain resolve within 6 week.
Pain that is constant and severe. Pain
that wakes you up at night. In my
experience, night pain and unrelenting
pain are the mostworrisome symptoms
that are commonly ignored in the
evaluation of patients with back pain.
2. Location and radiation of
the pain. Pain that originates from
muscular or ligamentous strain or
from disc disease without nerve
involvement is located primarily in
the back, possibly with radiation
into the buttocks or thighs. Pain that
radiates below the knee is a red flag
for a herniated disc or nerve root
compression. More than 90% of
herniated discs occur at the L4-5 or
the L5-S1 disk space. This will cause
symptoms such as pain, numbness
and weakness typically in one leg.
3. Age - Back pain in patients
younger than 18 years or older
than 50 years constitutes a red flag.
In both groups, back pain is more likely
to have a serious cause such as tumor
or infection. Patients under age 18
have a higher incidence of congenital
and bony abnormalities, such as
spondylolisthesis or spondylolysis,
than older patients. In patients older
than 50 years, nonmechanical causes,
such as a rupturing abdominal aortic
aneurysm or other intra-abdominal
processes, are more common. Spinal
stenosis resulting from hypertrophic
degenerative processes and from
degenerative spondylolisthesis is
more common in persons older than
4 . Sys temic complaint s .
Constitutional symptoms – such as
fever, chills, night sweats, malaise,
or undesired weight loss – suggest
infection or cancer. You are at risk
for infection especially if you have
diabetes, recent bacterial infection,
immunocompromised status, or
injection drug use. Back pain in
someone who recently underwent
a genitourinary or GI procedure
may predispose them to infection
secondary to bacteremia.
5. Most patients with benign
low back pain have no associated
neurologic deficits. Any severe
or rapidly progressive neurologic
deficit or complaint raises a red flag.
Neurological symptoms such as hand or
lower extremity numbness and tingling
and weakness. Rapidly progressing
neurological changes such as a drop
foot requires urgent attention.
6. Changes in bowel or bladder
habits. This is a severe problem
that often signifies compression of
the spinal cord or cauda equina and
requires emergency attention. An MRI
needs to be obtained to rule out severe
compression of the nerves that go to
the bowel and bladder.
7. If you suffered a major trauma
such as a fall from a height or a car
accident and have persistent pain you
should see a spine specialist to rule out
a fracture or disc herniation.
Please send me your “red flag” questions: firstname.lastname@example.org